Healthcare Provider Details

I. General information

NPI: 1265029839
Provider Name (Legal Business Name): MIGRANT HEALTH CENTER WESTERN REGION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 12/29/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOLAR A 119 CALLE LUIS MONTALVO BO. MARAVILLA NORTE
LAS MARIAS PR
00670
US

IV. Provider business mailing address

PO BOX 190
MAYAGUEZ PR
00681-0190
US

V. Phone/Fax

Practice location:
  • Phone: 787-827-3798
  • Fax: 787-832-0740
Mailing address:
  • Phone: 787-613-6918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DOLORES MORALES
Title or Position: DIRECTORA EJECUTIVA
Credential: SRA.
Phone: 787-613-6918